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Comparison of two echocardiography-based methods for evaluating pediatric left ventricular diastolic dysfunction
Xue Xiang1, Xu Zhu1, Min Zheng1
1Department of Ultrasound, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
Insights
The Z value-based criteria may identify left ventricular diastolic dysfunction (LVDD) earlier in children with heart failure (HF) and high-risk HF compared to guideline recommendations. This approach aids in timely treatment interventions for pediatric cardiovascular health.
Area of Science:
- Pediatric Cardiology
- Echocardiography
- Cardiovascular Imaging
Background:
- Left ventricular diastolic function (LVDF) assessment in children is crucial for managing heart failure (HF).
- Current guidelines from the American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) provide a framework for LVDF evaluation.
- Alternative methods, such as body surface area (BSA)-transformed Z value cut-offs, are being explored for improved diagnostic accuracy.
Purpose of the Study:
- To compare the consistency of LVDF assessment between the 2016 ASE/EACVI guideline recommendations and BSA-transformed Z value cut-offs in pediatric populations.
- To evaluate the diagnostic performance of these two criteria in children with established heart failure and those at high or low risk of HF.
Main Methods:
- Echocardiographic parameters including mitral annular e' velocity, lateral E/e' ratio, left atrial volume index, and peak tricuspid regurgitation velocity were measured.
- LVDF was assessed using both the 2016 ASE/EACVI guideline criteria and BSA-transformed Z value cut-offs.
- Consistency and differences between the two criteria were analyzed in cohorts of children with HF, high-risk HF, and low-risk HF.
Main Results:
- Moderate consistency was observed between the two criteria for evaluating LVDF in children with HF (kappa=0.566) and high-risk HF (kappa=0.468).
- The Z value-based criteria identified a higher positivity rate for left ventricular diastolic dysfunction (LVDD) in HF (23.5%) and high-risk HF (8.5%) groups compared to guideline criteria (15.6% and 3.2%, respectively).
- Moderate consistency was also found in grading LVDD severity (kappa=0.522), with Z value criteria indicating more severe LVDD.
Conclusions:
- The BSA-transformed Z value-based criteria may offer enhanced sensitivity for early detection of LVDD in pediatric HF and high-risk HF populations.
- This approach holds potential for facilitating earlier therapeutic interventions in children with diastolic dysfunction.
- Further research may refine the application of Z value-based criteria for pediatric LVDF assessment.
Objectives:
To investigate the consistency between the 2016 America Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guideline-based recommendations and the body surface area (BSA)-transformed Z value-based cut-off for the assessment of left ventricular diastolic function (LVDF) in children.
Methods:
Clinical data of children with heart failure (HF) and those with a high risk of HF and a low risk of HF were collected from the Children's Hospital of Chongqing Medical University between March 2021 and October 2022. The mitral annular e' velocity, lateral E/e' ratio, left atrial volume index, and peak tricuspid regurgitation velocity were detected by Echocardiography. The cut-off values recommended by the 2016 ASE/EACVI guidelines and the cut-off value based on the BSA-transformed Z value were used to evaluate LVDF. The consistencies and differences of the two criteria were compared.
Results:
A total of 132 children with HF, 189 with a high risk of HF, and 231 with a low risk of HF, were enrolled. The consistency of the two criteria in evaluating LVDF in children with HF and with high risk of HF was moderate, with weighted kappa coefficients of 0.566 and 0.468, respectively (P < 0.001). The positivity rate of left ventricular diastolic dysfunction (LVDD) with Z value-based criteria (HF group, 23.5%; high-risk group, 8.5%) was higher than that with guideline-based criteria (HF group, 15.6%; high-risk group, 3.2%). In children with a low risk of HF, no case with LVDD was found. The consistency between the two criteria for grading the degree of LVDD was moderate, with a kappa coefficient of 0.522 (P = 0.001). The degree of LVDD according to the Z value-based criteria was higher than that of the guideline-based criteria (P = 0.004).
Conclusions:
The Z value-based criteria used to evaluate LVDD in children with HF and high risk of HF may be more conducive to the early identification of LVDD, thereby permitting the possibility of early treatment intervention.
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